Provider Demographics
NPI:1144717562
Name:BIGELSEN, LILA (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:LILA
Middle Name:
Last Name:BIGELSEN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11854 LAKESHORE N
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 N SUNRISE AVE STE 1308
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2933
Practice Address - Country:US
Practice Address - Phone:916-755-4930
Practice Address - Fax:916-742-5942
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12873171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist